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Radical hysterectomy

Radical hysterectomy is an operation done to treat some cancers of the cervix. The surgeon takes out the uterus and the ligaments (tissue fibers) that hold it in place in the pelvis. The cervix and an inch or two of the deep vagina around the cervix are also removed. A hysterectomy for uterine or ovarian cancer removes less tissue.

After taking out the cervix, the surgeon stitches the vagina at its top. Some fluid drains from the vagina during healing. The top of the vagina soon seals with scar tissue and becomes a closed tube. The vagina does not, as some women fear, become an open tunnel into the pelvis.

The ovaries may or may not be removed

If a woman is under the age of 40, the surgeon will often try to leave an ovary or part of one during a hysterectomy. Even one ovary can produce enough hormones to keep a woman from going through early menopause. Because the uterus is removed, a woman will not have menstrual periods and she will not be able to carry a pregnancy.

If a woman is between 40 and 50 when she has surgery, doctors weigh the benefits of removing both ovaries to prevent ovarian cancer against the costs of causing sudden early menopause. Women should discuss these choices with their doctor before surgery. Many cancer centers have sexual health programs where trained health care professionals (gynecologists and sex therapists) can help women with any concerns. Women can also talk with other women before surgery so they can discuss their concerns about how surgery will affect their sexual function.

A surgeon most often removes both ovaries in women over the age of 50 having this surgery.

Effects of hysterectomy on bladder function

A radical hysterectomy can affect a woman’s ability to pass urine while the nerves in the tissue around the uterus are recovering from surgery. However, with new surgical techniques and nerve-sparing surgery, problems like this are less common. Some doctors may leave a catheter in place for a few days after surgery to reduce urinary problems.

If a woman still cannot fully empty her bladder a few weeks after surgery, she may have long-term damage. To prevent urinary tract infections, she may be taught to slip a small tube, called a catheter, through the urethra and into the bladder to drain out the remaining urine. This is called self-catheterizing. A few women may need to do this several times a day for the rest of their lives. If you are self-catheterizing, make sure your bladder is empty before intercourse to help prevent urinary tract infections or discomfort during sex.

Effects of hysterectomy on sexual function

Hysterectomy does not usually change a woman’s ability to feel sexual pleasure. The vagina is shortened, but the area around the clitoris and the lining of the vagina generally stay as sensitive as before.

Some women feel less feminine after a hysterectomy. They may view themselves as “empty,” or not feel like a “real” woman. Such negative thoughts can keep women from thinking about and enjoying the sexual function that they still have. A trained therapist often can help with such concerns.

If cancer is causing pain or bleeding with vaginal penetration, a hysterectomy can help stop those symptoms and actually improve a woman’s sex life. The vagina might be shorter after surgery, but couples usually adjust to this change. Extra time spent on caressing and other forms of foreplay can help ensure that the vagina has lengthened enough to allow penetration. It’s also important for the vagina to have moisture to allow the tissues to stretch and move. (See the section called “Vaginal dryness.”)

If the vagina seems too shallow, there are ways a woman can give her male partner the feeling of more depth. For instance, she may spread some lubricating gel on her outer genital lips and the tops of her thighs and press her thighs together during intercourse. She can also cup her hands around the base of her partner’s penis during intercourse.

Orgasm after radical hysterectomy

Women who have had a radical hysterectomy sometimes ask if the surgery will affect their ability to have orgasms. This has not been studied a great deal, and there isn’t as much information as we’d like. One study in Denmark looked at the effect of radical hysterectomy on sexual function by comparing women who had the surgery to women who hadn’t. The women had the surgery for stage I or stage IIA cervical cancer. (This means that the cancer had not spread into the tissues next to the cervix, even though it may have grown into the upper part of the vagina.)

Just after the surgery, more than 1 in 10 women noticed problems with lubrication and pain during sex. Almost 8 in 10 women reported little or no interest in sex. Compared to women who didn’t have surgery, about twice as many reported problems reaching orgasm. Nearly 1 in 5 said that their vaginas felt too small.

The good news is that most of the reported problems were gone by 6 months after the surgery. By the end of 2 years, 9 out of 10 women were back to having sex. At that point, the number of women who usually had orgasms during sex was about the same as that of the women who hadn’t had surgery.

Sex problems are likely to be somewhat worse and last longer for women who have pelvic radiation along with radical hysterectomy. See the section called “Sex and pelvic radiation therapy” for more on this.